The role of intra-operative motor evoked potentials in the optimization of chronic cortical stimulation for the treatment of neuropathic pain

The rat spinal cord isolated from supraspinal control via a complete low- to midthoracic spinal cord transection produces locomotor-like patterns in the hindlimbs when facilitated pharmacologically and/or by epidural electrical stimulation. To evaluate the role of epidural electrical stimulation in enabling motor control (eEmc) for locomotion and posture, we recorded potentials evoked by epidural spinal cord stimulation in selected hindlimb muscles during stepping and standing in adult spinal rats. We hypothesized that the temporal details of the phase-dependent modulation of these evoked potentials in selected hindlimb muscles while performing a motor task in the unanesthetized state would be predictive of the potential of the spinal circuitries to generate stepping. To test this hypothesis, we characterized soleus and tibialis anterior (TA) muscle responses as middle response (MR; 4–6 ms) or late responses (LRs; >7 ms) during stepping with eEmc. We then compared these responses to the stepping parameters with and without a serotoninergic agonist (quipazine) or a glycinergic blocker (strychnine). Quipazine inhibited the MRs induced by eEmc during nonweight-bearing standing but facilitated locomotion and increased the amplitude and number of LRs induced by eEmc during stepping. Strychnine facilitated stepping and reorganized the LRs pattern in the soleus. The LRs in the TA remained relatively stable at varying loads and speeds during locomotion, whereas the LRs in the soleus were strongly modulated by both of these variables. These data suggest that LRs facilitated electrically and/or pharmacologically are not time-locked to the stimulation pulse but are highly correlated to the stepping patterns of spinal rats.

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Diagnosis of psychogenic paralysis: The role of motor evoked potentials

Journal of Neurology ◽

10.1007/s004150170075 ◽

2001 ◽

Vol 248 (10) ◽

pp. 889-897 ◽

Cited By ~ 24

Author(s):

Roberto Cantello ◽

Cristina Boccagni ◽

Cristoforo Comi ◽

Carlo Civardi ◽

Francesco Monaco

Keyword(s):

Evoked Potentials ◽

Motor Evoked Potentials

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14 DIAGNOSTIC ROLE OF LASER EVOKED POTENTIALS IN CENTRAL NEUROPATHIC PAIN

European Journal of Pain ◽

10.1016/j.ejpain.2007.03.028 ◽

2007 ◽

Vol 11 (S1) ◽

pp. S6-S7

Author(s):

L. Garcia-Larrea

Keyword(s):

Neuropathic Pain ◽

Evoked Potentials ◽

Laser Evoked Potentials ◽

Central Neuropathic Pain ◽

Diagnostic Role

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Intra-operative monitoring of lower extremity motor-evoked potentials by direct cortical stimulation

Clinical Neurophysiology ◽

10.1016/j.clinph.2011.09.025 ◽

2012 ◽

Vol 123 (6) ◽

pp. 1248-1254 ◽

Cited By ~ 15

Author(s):

Yuichi Maruta ◽

Masami Fujii ◽

Hirochika Imoto ◽

Sadahiro Nomura ◽

Fumiaki Oka ◽

...

Keyword(s):

Lower Extremity ◽

Evoked Potentials ◽

Motor Evoked Potentials ◽

Cortical Stimulation ◽

Direct Cortical Stimulation ◽

Operative Monitoring

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Neuroprotection for Spine Surgery

10.1093/med/9780190280253.003.0020 ◽

2017 ◽

Author(s):

Jess W. Brallier ◽

Jonathan S. Gal

Keyword(s):

Evoked Potentials ◽

Spine Surgery ◽

Motor Evoked Potentials ◽

Neurologic Injury ◽

Arterial Blood ◽

Increased Risk ◽

Physiologic Parameter ◽

The Common ◽

Transcranial Motor Evoked Potentials

Perioperative neurologic injury related to spine surgery, albeit rare, can result in devastating functional loss. As the number of spine operations has increased, so has the need for strategies designed to avoid and protect against such injury. This chapter reviews the common etiologies of neurologic deficits secondary to spine surgery and the factors that place patients at increased risk for developing these complications. The use of intraoperative neuromonitoring, including somatosensory evoked potentials (SSEPs), electromyography (EMG), and transcranial motor evoked potentials (TcMEPs), to detect surgical trespass of neuronal elements is also reviewed. The authors also summarize the role of physiologic parameter optimization, including mean arterial blood pressure and body temperature, and pharmacologic interventions, should an injury occur. Current practice guidelines for preventing and managing perioperative neurologic injury are described.

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Neurophysiologic Monitoring

10.1093/med/9780190850036.003.0028 ◽

2018 ◽

Author(s):

Antoun Koht ◽

Tod B. Sloan

Keyword(s):

Evoked Potentials ◽

Motor Evoked Potentials ◽

Auditory Brainstem ◽

Auditory Brainstem Responses ◽

Corrective Surgery ◽

Neurophysiologic Monitoring ◽

Intraoperative Neurophysiologic Monitoring ◽

Evoked Electromyography ◽

Signal Evaluation

Intraoperative neurophysiologic monitoring is used for monitoring and mapping of neurological structures during surgery and procedures where the neurological structures are at risk. Among the most commonly used techniques are electrophysiologic techniques, which include spontaneous and evoked electromyography, somatosensory evoked potentials, motor evoked potentials, electroencephalography, and auditory brainstem responses. These methods differ in their responses to anesthesia and in their clinical contribution to monitoring because of differing anatomy. Their use in spinal corrective surgery highlights the role of the anesthesiologist during cases when these techniques are utilized. Optimization of anesthesia, position, and physiology provide better monitoring conditions, enhance signal evaluation, and may lead to better neurological outcome.

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